Anatomic outcomes after retinal detachment surgery in patients with retinal detachment associated with choroidal detachment

PURPOSE: To investigate relationships between preoperative and intraoperative characteristics with outcome variables in patients suffering from primary rhegmatogenous retinal detachment (RRD) or traction retinal detachment (TRD) complicated by serous choroidal detachment (CD). Choroidal detachment is a rare complication of retinal detachment and the current literature cites generally poor visual outcome variables. By investigating a retrospective case series, we hope to elucidate new relationships and embolden existing ones so that future physicians can make more educated decisions regarding the care for these complicated patients. METHODS: A retrospective case series analyzed 18 patient’s medical records (18 eyes) who had been diagnosed and surgically treated for RRD or TRD associated with a CD at the Longwood Medical Eye Center at Beth Israel Deaconess Medical Center. Patients with RDCD who had undergone 23-gauge pars plana vitrectomy with silicone oil tamponade were selected. Exclusionary criteria included ocular complications such as phthisis bulbi and open globe trauma. Patients experienced a variety of surgical procedures including by not limited to relaxing retinotomy (n=12 eyes), choroidal drainage (n=10 eyes), endoscopy-assisted PPV (n=10 eyes), and ERM peeling (n=8 eyes). Primary outcome variables tabulated were primary and final anatomic success, defined as successful reattachment of the retina to the underlying choroid, and final visual acuity. RESULTS: The mean age of the sample group was 69 with 8 patients (44%) diagnosed with preoperative hypotony (IOP <= 6 mmHg). A total of 12 patients were pseudophakic (67%). With a mean follow-up of 21.6 months, patients exhibited expected visual outcomes with 6 patients (33%) improving visual acuity and 7 patients (39%) decreasing visual acuity. Final anatomic success was seen in 17 cases (94%). A significant correlation was found between decreased number of previous surgeries and better visual outcomes (change in BCVA). Another significant relationship correlates choroidal drainage with worse visual outcomes (change in BCVA). Finally, patients who received ERM peeling had better rates of primary anatomic success. CONCLUSION: The advanced age of the sample lends itself to increased risk for cataracts and thus pseudophakia. In addition, high rates of diabetes and macular degeneration follow. The pathophysiology of RDCD in relation to the risk factors of hypotony and macular holes is possibly based on the Starling forces and favorable fluid transudation into the suprachoroidal space. Although the outcomes of this study were similar to previous literature, the visual outcomes are still poor at best. Reducing the number of previous, invasive, ocular surgeries was seen to be correlated with better visual outcomes. In addition, performing ERM peels is seen to be correlated with improved rates of primary anatomic success. More research is required on the etiology of the disease process and a case-controlled longitudinal study may be helpful in determining more relationships with outcome variables

Beyond the echo chamber:Modelling open-mindedness in citizens’ assemblies

A Citizens’ assembly (CA) is a democratic innovation tool where a randomly selected group of citizens deliberate a topic over multiple rounds to generate, and then vote upon, policy recommendations. Despite growing popularity, little work exists on understanding how CA inputs, such as the expert selection process and the mixing method used for discussion groups, affect results. In this work, we model CA deliberation and opinion change as a multi-agent systems problem. We introduce and formalise a set of criteria for evaluating successful CAs using insight from previous CA trials and theoretical results. Although real-world trials meet these criteria, we show that finding a model that does so is non-trivial; through simulations and theoretical arguments, we show that established opinion change models fail at least one of these criteria. We therefore propose an augmented opinion change model with a latent ‘open-mindedness’ variable, which sufficiently captures people’s propensity to change opinion. We show that data from the CA of Scotland indicates a latent variable both exists and resembles the concept of open-mindedness in the literature. We calibrate parameters against real CA data, demonstrating our model’s ecological validity, before running simulations across a range of realistic global parameters, with each simulation satisfying our criteria. Specifically, simulations meet criteria regardless of expert selection, expert ordering, participant extremism, and sub-optimal participant grouping, which has ramifications for optimised algorithmic approaches in the computational CA space

Radiographic Union Scoring Scale for Determining Consolidation Rates in the Calcaneus.

The reliable evaluation of osseous consolidation after hindfoot osteotomy can be difficult. Concomitant hindfoot osteotomies often dictate the advancement of weightbearing, and radiographs are the mainstay imaging tool owing to cost, efficiency, and radiation exposure. Understanding the radiographic parameters that can be used to reliably determine osseous healing is paramount. However, currently, no reliable or validated method is available to determine osseous healing of hindfoot osteotomies in irregular bones of the foot. The purpose of the present study was to develop a radiographic healing scoring system that would enhance the diagnostic healing assessment after elective calcaneal osteotomy. We adapted existing orthopedic scales validated for healing in the leg for application in the irregular bones of the foot. A total of 168 cases were evaluated by 6 blinded assessors to test the interrater reliability of subjective healing assessment compared with the proposed scoring system. The radiographs were classified by postoperative period: ≤4 weeks, 5 to 12 weeks, and \u3e12 weeks. The proposed scale had high interrater reliability but was burdensome. Using a priori item reduction protocols, a limited 6-item scale further improved internal consistency and reduced the burden. The result was excellent interrater reliability (α = 0.98, standard deviation 0.02, 95% confidence interval 0.91 to 0.96) among all assessors when using the scoring scale compared with unacceptable reliability (α = 0.438) for subjective osteotomy healing. The reliability of our system appeared superior to that of subjective assessment of osseous healing alone, even in the absence of clinical correlates after osteotomy of the calcaneus

Brexit and the everyday politics of emotion: methodological lessons from history

The 2016 European Union referendum campaign has been depicted as a battle between ‘heads’ and ‘hearts’, reason and emotion. Voters’ propensity to trust their feelings over expert knowledge has sparked debate about the future of democratic politics in what is increasingly believed to be an ‘age of emotion’. In this article, we argue that we can learn from the ways that historians have approached the study of emotions and everyday politics to help us make sense of this present moment. Drawing on William Reddy’s concept of ‘emotional regimes’, we analyse the position of emotion in qualitative, ‘everyday narratives’ about the 2016 European Union referendum. Using new evidence from the Mass Observation Archive, we argue that while reason and emotion are inextricable facets of political decision-making, citizens themselves understand the two processes as distinct and competing

Forage fish interactions: A symposium on creating the tools for ecosystem-based management of marine resources

Forage fish (FF) have a unique position within marine foodwebs and the development of sustainable harvest strategies for FF will be a critical step in advancing and implementing the broader, ecosystem-based management of marine systems. In all, 70 scientists from 16 nations gathered for a symposium on 12–14 November 2012 that was designed to address three key questions regarding the effective management of FF and their ecosystems: (i) how do environmental factors and predator–prey interactions drive the productivity and distribution of FF stocks across ecosystems worldwide, (ii) what are the economic and ecological costs and benefits of different FF management strategies, and (iii) do commonalities exist across ecosystems in terms of the effective management of FF exploitation

Minimum Technical Data Elements for Liquid Biopsy Data Submitted to Public Databases

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154656/1/cpt1747.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154656/2/cpt1747-sup-0001-FigS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154656/3/cpt1747_am.pd

Concept, Design and Implementation of a Cardiovascular Gene-Centric 50 K SNP Array for Large-Scale Genomic Association Studies

A wealth of genetic associations for cardiovascular and metabolic phenotypes in humans has been accumulating over the last decade, in particular a large number of loci derived from recent genome wide association studies (GWAS). True complex disease-associated loci often exert modest effects, so their delineation currently requires integration of diverse phenotypic data from large studies to ensure robust meta-analyses. We have designed a gene-centric 50 K single nucleotide polymorphism (SNP) array to assess potentially relevant loci across a range of cardiovascular, metabolic and inflammatory syndromes. The array utilizes a “cosmopolitan” tagging approach to capture the genetic diversity across ∼2,000 loci in populations represented in the HapMap and SeattleSNPs projects. The array content is informed by GWAS of vascular and inflammatory disease, expression quantitative trait loci implicated in atherosclerosis, pathway based approaches and comprehensive literature searching. The custom flexibility of the array platform facilitated interrogation of loci at differing stringencies, according to a gene prioritization strategy that allows saturation of high priority loci with a greater density of markers than the existing GWAS tools, particularly in African HapMap samples. We also demonstrate that the IBC array can be used to complement GWAS, increasing coverage in high priority CVD-related loci across all major HapMap populations. DNA from over 200,000 extensively phenotyped individuals will be genotyped with this array with a significant portion of the generated data being released into the academic domain facilitating in silico replication attempts, analyses of rare variants and cross-cohort meta-analyses in diverse populations. These datasets will also facilitate more robust secondary analyses, such as explorations with alternative genetic models, epistasis and gene-environment interactions